The technical aspects of rotator cuff repair involve placing small screws in the upper portion of the arm bone (humerus) where the rotator cuff tendon normally attaches. The screws are called suture anchors and are made from a special form of biodegradable plastic that the body will naturally absorb over time. The suture anchors are armed with high strength sutures that are then placed through the torn tendon, and through a variety of pulley-type techniques the tendon is returned back to the bone at the location of the anchor.
Even after the rotator cuff tendon has been repaired back to the humerus bone, optimal success from the operation is not achieved unless there is true biologic healing of the tendon back down to the bone. This is a process that occurs very slowly over time thus explaining the need for strict protection of the shoulder following surgery.
Patients are placed into a specialized sling which they are expected to wear for 4 to 6 weeks after surgery. The sling can be removed for bathing and changing clothes and for appropriate physical therapy, but no purposeful, active movement of the shoulder is permitted as this can compromise the healing process. The optimal approach to physical therapy following rotator cuff repair remains a topic of ongoing research without widespread consensus. Most research favors a very slow progression of therapy, with a brief period of complete rest followed by several weeks of passive movement of the shoulder where the patient does not assist in the movement of the arm. Over time active lifting of the arm is permitted followed by a program of strengthening.
Pain management following rotator cuff repair involves the use appropriate pain medication and liberal use of ice. Frequent icing has been shown to have a profound effect on postoperative pain. We also utilize nerve blocks in almost all rotator cuff surgeries. The block, administered by an anesthesiologist just prior to surgery, uses a long acting numbing agent which affords the patient complete relief of shoulder pain for many hours following surgery. As the block begins to wear off patients are able to anticipate the pain that will follow and start treating it with their prescribed medication before the pain starts.